NJM Insurance Group has an opening for a Coding & Reimbursement Specialist in its Medical Claim Services Department. The location for this position will be based in West Trenton. The department is seeking an individual that can be a team player while accurately and efficiently auditing medical bills by applying the correct medical, coding, and regulatory guidelines.

Job Responsibilities:

• Accurately and clearly apply regulatory, coding, and medical guidelines, as well as company policies and procedures to audited bills.
• Bill negotiation.
• Provide concise and clear instructions for bill processing. For those procedures requiring audit reports, cite relevant resources, when appropriate.
• Conduct ongoing review and/or audit of bills as needed for appeals, demands for arbitration, and suit. Provide concise and clear audit reports, including rationale for denials and/or reductions, citing relevant resources and supplying supporting documentation, when necessary.
• Keep abreast of industry trends and requirements that impact the auditing process. Research new procedures and technology and provide feedback to team and management on implications.
• Recommend value-add strategies for addressing new trends and services.
• Report on tasks, audit volume, output, savings, etc., as needed and required by supervisor and/or management.
• Complete continuing education credits needed to maintain certification(s).

Required Qualifications and Experience:

• High School Diploma/GED required
• Bachelor’s Degree preferred
• Knowledge of Excel, Word and Outlook
• Strong communication and writing skills
• Accuracy and attention to detail

Preferred Experience:

• Knowledge of PIP, Workers Compensation, and/or Medicare coding regulations and guidelines
• Knowledge of Mitchell DecisionPoint and/or Guidewire Claim Center
• Certified Professional Coder (CPC) designation

Legal Disclaimer: NJM is proud to be an equal opportunity employer. We are committed to attracting, retaining and promoting a diverse and inclusive workforce that is fully representative of the diversity that exists in the communities in which we do business.